There are some who claim that the Brewer perspective is unsupported by credible studies. There are also some who claim that
the only studies who support the Brewer teachings are those which were conducted by Dr. Brewer himself. There are also some
who claim that there are no recent studies which support the Brewer point of view.

The truth is that long before Tom Brewer arrived at medical school there were many studies supporting this perspective on
nutrition in pregnancy. Then when he entered medical school this way of thinking was taught in his obstetric textbook, and
one of his professors of obstetrics (Ferguson) taught this perspective in class, ideas that Ferguson himself had learned from
another professor from Germany (Dieckmann), at the Chicago Lying-In Hospital. Then all through the five decades of Dr. Brewer's
career there were independent studies which supported his point of view.

It is also true that as recently as 2006 there have been studies supporting the Brewer point of view on the link between restricted-salt
diets and elevated blood pressure in pregnancy.

You may have heard the claim that research has shown that it's a myth that women following this diet will not develop pre-eclampsia.

You may also have heard the claim that it has been proven that using the Brewer Diet does not aid in the prevention of pre-eclampsia
or HELLP Syndrome.

The truth is that there is no research that has shown that it's a myth that women following this diet will not
develop pre-eclampsia--at least not that I have heard of.

The truth is also that it has not been proven that using the Brewer Diet does not aid in the prevention of pre-eclampsia
or HELLP Syndrome.

The truth is that while some mainstream researchers are trying to find the cause of pre-eclampsia, the fact that they do not
believe in the nutritional causes of pre-eclampsia does not make it so.

The truth is that while those researchers may find some interesting features of the placentas experiencing PE, and various
substances secreted by bodies experiencing PE, and the genetics of bodies experiencing PE, those findings are not proof that
those findings are the causes of PE. They could be just interesting features of bodies undergoing the changes
already described by Dr. Brewer, and other researchers who came before him, and other researchers who came after him. Finding
other interesting features of events surrounding and resulting from the process of PE does not provide any proof that Dr.
Brewer's description of the "Perfect Storm" leading to PE is inaccurate.

The truth is that in one study where the mainstream researchers were trying to explore whether the use of IV human albumin
was effective in the treatment of PE, and appeared to find it to be ineffective, they had also kept the mothers on their "anti-hypertensive
therapies", which probably included low-salt, low-calorie diets, and which probably counteracted the benefits of the IV albumin
which the mothers were getting.

The truth is that researchers who do not understand the basic principles of the Brewer description of the PE process cannot
be expected to accurately conduct research regarding the question of whether those principles are valid.

There are many possible reasons why some people who believe that they have tried the Brewer Diet go on to develop PE in spite
of their best efforts. Some of them might include...

--They might have been taught the diet incorrectly.
--They might have received inadequate nutritional counseling and support.
--They might have inadvertently been on a diet with less calories than they needed.
--They might have inadvertently been on a diet with less salt than they needed.
--They might have inadvertently been on a diet with less protein than they needed.
--They might have had an intense form of nausea or vomiting lasting longer than 3 months.
--They might have been experiencing a lot of stress at work or at home.
--They may have had a job or home life or exercise program that used a lot of calories, and they may not have been counseled
to eat extra calories to make up for that loss.
--They might have been experiencing a disruption in their eating patterns by a move or by a trip.
--They might have been misdiagnosed initially and may have developed PE as a result of an inadequate differential diagnosis
and incorrect treatment (such as being put on a low-salt diet).
--They might have been pregnant during a period of time when they were exposed to over-heated conditions (hot weather, over-heated
work conditions, or over-heated homes).
--They might have been using some herbs that have diuretic properties.
--They might have experienced a bout with the flu,
or some other digestive disorder which inhibited their food intake.
--They might have a pre-existing condition from before the pregnancy which developed into PE.
--Or all of the above, or any combination of the above.

I've seen comments on more than one website or message board that taught or implied that drinking a gallon of water a day
was part of the Brewer Diet, and/or would prevent pre-eclampsia or blood pressure problems.

The truth is that Dr. Brewer's view was that, while fluids are a necessary part of prenatal nutrition to prevent low blood
volume and dehydration, when the stomach gets crowded by the growing uterus a woman needs to be careful to not put anything
in that stomach that will not give her the nutrients and calories that she needs. So he recommended that she get her fluids
from milk and 100% juices (no sweeteners added). If a woman does drink a gallon of water a day, she could cause her stomach
to feel full, which could lead to her eating less food, which could lead to her not getting enough calories and protein and
sodium in her diet, which could lead to a falling blood volume, which could lead to various complications, including pre-eclampsia.
All the while, she could believe that she was on the Brewer Diet and that the diet was not working for her.

In pregnancy, diuretics increase the mother's urinary output, which decreases her blood volume at the very time in
her life when her body is continually working to increase her blood volume. Then when the kidneys perceive that the
blood volume is too low, they secrete renin, which constricts the capillaries, which makes the blood pressure rise.

The kidneys also start to conserve fluid to try to raise the blood volume. But if there's not enough salt, calories, and
protein in the diet to create enough osmotic pressure to hold that fluid in the bloodstream, it will move out of the capillaries
into the tissues of the ankles, fingers, or face, thus creating edema (swelling).

If a woman is taking nettle or dandelion, being on the Brewer Diet may not be enough to keep her blood volume where it needs
to be, because of the diuretic actions of those herbs. In such a situation, the mother may see a rising blood pressure and
edema, in spite of her best efforts to follow the Brewer Diet.

I've seen at least one website that purported to list all the elements of the Brewer Diet. But it listed the 4 servings of
the "Milk Group" and the 2 servings of the "Egg Group" and all the other food groups on the Brewer Diet, but completely left
out the additional servings of the "Protein Group". If a woman followed that diet, she would be getting only 44 grams of protein
each day. As a result of the low level of protein, calories and sodium in that diet, a pregnant woman could follow the diet
thinking that she was on the Brewer Diet, and still develop complications from low blood volume, such as pre-eclampsia. Then
she could say that the Brewer Diet didn't work, when she wasn't really on it at all.

The truth is that the Brewer Diet includes 14 food groups (if you count snacks and supplements), including 4 servings of milk
products or milk substitutes, 2 servings of eggs, plus 6-8 1-oz servings of other proteins.

Some prenatal classes teach that after the 4 servings of the "Milk Group", and the 2 servings of the "Egg Group", you need
only 2 3-oz servings from the "Protein Group". This could cause some confusion, since later Brewer books teach that the protein
servings should be 1 oz. each. If a woman followed the charts of this prenatal class and got only 2 servings of the "Protein
Group" and used the 1 oz. servings of the later Brewer books, she could think that she was on the Brewer Diet when she really
wasn't, and she could believe that the diet didn't work for her, when she wasn't actually on it.

The 2-serving version of the "Protein Group" was the recommendation from the first Brewer book written for consumers,
What Every Pregnant Woman Should Know. In that book the servings of protein were about 3 oz. each, with varying numbers
of grams of protein in each serving. In later books, the Brewers standardized the protein servings, so that following your
diet could be done without the need for protein counters. They changed the description of the diet to say that the mother
should have 6-8 servings from the "Protein Group", with each serving being 1 oz., instead of 3 oz.

I've had feedback that there was a belief out there that the Brewer Diet recommended that the mother drink a gallon of milk
a day.

The truth is that the Brewer Diet recommends only 4 cups of milk a day, or the equivalent. For each cup of milk, the mother
can substitute a cup of yogurt, 1/4 cottage cheese, a large slice of cheese, or 1 cup soy milk. If the mother wants to add
more milk or milk products to satisfy some of the servings in the "Protein Group" that is permissable, but it's not required.

If a mother seems to be developing pre-eclampsia, she can increase her protein intake by eating 17-18 eggs a day and 2 quarts
of milk a day for 3 days. But that is a strategy that should be used only in special situations where the mother seems to
be developing elevated blood pressure or pre-eclampsia.

You may see claims on some websites that Dr. Brewer or the Brewer Diet blames women for having developed pre-eclampsia and
other related complications.

The truth is that nothing could be further from the truth. Dr. Brewer got the most frustrated with doctors, with drug companies,
and with professional organizations which gave women low-salt and/or low-calorie diets and sometimes put them on diuretic
drugs, which put them on the track of a falling blood volume, which then helped them to develop pre-eclampsia or related complications.
His heart and passion and compassion were with the women who were the victims of this misguided medical care, and he did
all that he could to communicate to them the importance of their being their own advocates in this issue, in the absence of
that advocacy from their doctors. Women have known for a long time that they need to be their own advocates on many issues,
and this one is no different.

Brewer: "Our culture has a long history of treating women as inferior, and that's especially true in medicine. Women who educate
themselves, listen to their bodies, stay away from prescription drugs, and feed themselves the way healthy women have fed
themselves for thousands of years, not the way Americans are feeding themselves today on low-fat, low-protein, high-carbohydrate,
low-salt, low-calorie foods--those enlightened women are going to have healthy, full-term pregnancies with no complications."

There are some mothers who, sometimes on their own and sometimes on the advice of their doctors or midwives, are concerned
about gaining too much weight. So they may decide to eat the protein of the Brewer Diet without eating the calories recommended
by the Brewer Diet. By doing this they might believe themselves to be on the Brewer Diet, and when they develop pre-eclampsia
or related complications, they might conclude that the Brewer Diet must be a fallacy.

The truth is that the Brewer Diet is designed as a holistic way of facilitating the expansion of the mother's blood volume,
which is what her body is trying to do to preserve the pregnancy and nourish the baby. As part of that design, the diet includes
calories and salt and other nutrients, as well as protein. If the mother eats even just 1/3 less calories than Dr. Brewer
recommended (1/3 less than 2600 is about 1700), her body will resort to burning half of her protein intake for
calories, and her blood volume will not be able to keep up with her body's needs. So even if she's eating 80-120 grams of
protein, her body will be able to use only 40-60 of it for albumin-making, blood building, uterus building, and baby building,
and the mother who believes that she's following the Brewer Diet might develop pre-eclampsia and come to the conclusion that
it didn't work for her and therefore must be a fallacy.

There are some mothers who, sometimes on their own and sometimes on the advice of their doctors or midwives, are concerned
about the issue of edema, or swelling. So they may decide to eat the protein of the Brewer Diet without eating the salt recommended
by the Brewer Diet. By doing this they might believe themselves to be on the Brewer Diet, and when they develop pre-eclampsia
or related complications, they might conclude that the Brewer Diet must be a fallacy.

The truth is that the Brewer Diet is designed as a holistic way of facilitating the expansion of the mother's blood volume,
which is what her body is trying to do to preserve the pregnancy and nourish the baby. As part of that design, the diet includes
calories and salt and other nutrients, in addition to the protein. When there is adequate salt/sodium in the mother's bloodstream,
it has osmotic pressure which can pull fluid out of the mother's tissues (ankles, fingers, and face) for the body to use in
its efforts to expand the blood volume. If the mother eats less salt than Dr. Brewer recommended, her body may not be able
to hold the fluid in her circulation, and it can move from her capillaries out into her tissues, and she may develop the very
edema she was trying to prevent, and her blood volume will not be able to keep up with her body's needs. So even if she's
eating 80-120 grams of protein, her body might not be able to expand her blood volume adequately, and the mother who believes
that she's following the Brewer Diet might develop pre-eclampsia and come to the conclusion that it didn't work for her.

You may have heard the claim that no studies have ever been done on the Brewer Diet, and that it was never published for peer-review
or confirmed by subsequent research.

The truth is that Dr. Brewer based his own research and practice and writings on the work of many other researchers who came
before him, and that his work was published in many professional journals, and that his work was supported by other independent
studies done in his own time. Some of those studies are listed in his books, and I am posting those studies on this website,
and I will add to them as I am able.

"After I finished my five-year contract with the clinics of Contra Costa County, I stayed on and worked with the people who
were hired to do a statistical study. I'd spent two years in Richmond, then two years at the county hospital in Martinez,
and then went to Pittsburgh, California, so I had worked at all three of the major county clinics. The data showed improvement
in every category. There was a period during which the Pittsburgh clinic continued to use conventional methods while I used
nutrition in the Richmond and Martinez clinics, so we used the Pittsburgh clinic as a control. The Pittsburgh clinic had 10
times more hypertension in first pregnancies than the Richmond and Martinez clinics. Those findings were published in the
Journal of Reproductive Medicine as a preliminary report. (51) A team of eight government researchers spent three years going
over 5600 cases. They studied every blood pressure reading, every urinalysis, and every other test recorded on the charts,
and they verified our results."

"The fact is that research has been done on this subject, but with the exception of folic acid, it stopped somewhere around
the 1980s when the focus shifted to drugs as the answer to curing all ills. The research that was done was not widely accepted
due to the fact that it could not include clinically controlled studies. It would not show common sense or ethics to starve
a group of pregnant women in order to supply a control group. The researchers did the logical thing and used the women's previous
diet and circumstances as the control (Brewer 1982). The results were amazing. Dr. Tom Brewer totally eradicated preeclampsia
in specific populations where the former rates were upwards of 40 percent. He had the women eat a healthy, varied, well-balanced
diet that included high quality foods, adequate protein and complex carbohydrates. He also had them drink water to thirst,
salt to taste and avoid drugs. Unfortunately, the National Institutes of Health refused to publish the results because he
couldn't do a clinically controlled study.

So what's the problem with pregnancy nutrition? The standard medical community does not believe that women need to eat this
way. Doctors keep saying that they don't know the cause of preeclampsia, but they are madly searching for a 'magic pill' or
single cause to shed some light on the mystery..."

"...This attitude means that the majority of women receive no education on nutrition in pregnancy. Desperate treatments of
preeclampsia, such as diuretics, elimination of salt intake and calorie and weight gain restriction, only exacerbate the problem
by further reducing and restricting much-needed blood volume (called hypovolemia) and reducing the blood supply to the placenta
and fetus."

You may have heard the claim that Dr. Brewer was just the author of "a bunch of pop pregnancy books."

The truth is that Dr. Brewer first became interested in MTLP before he became a medical student, when his Russian neighbor
was describing the horrific effects of the WWII starvation in Russia on pregnant mothers. Tom continued his interest in MTLP/pre-eclampsia
when he was a medical student and read in his obstetrics textbook about the "'nutritional' theory of the origin of toxemia
based on work done by Maurice Strauss and Bertha Burke at Harvard and Ferguson's work [one of his professors] seemed to confirm
it." He continued to study this perspective as he progressed through medical school and internship. While there, he observed
the treatments for pre-eclampsia that were the standards of care at that time, and the outcomes of those treatments, a process
that included "thousands of hours spent pouring over scientific reports." He went on to work for a couple of years in private
general practice in Fulton, Missouri, which included the care of 100 pregnancies with only one case of pre-eclampsia--one
case in which the woman was poor and malnourished and had had no prenatal care. "In 1958, Dr. Brewer completed a residency
in obstetrics and gynecology at the University of Miami Medical School where he was also a research fellow at the Howard Hughes
Medical Institute, studying the formation of collagen in the uterus during pregnancy, a process that is directly linked to
efficiency of labor."* Then, "in his last year at Miami's Jackson Memorial Hospital, Tom became chief OB/GYN resident with
the authority to test one of the results of his research: a new method of managing the mother acutely ill with MTLP...human
serum albumin...It worked...Since then other researchers have confirmed his clinical trials." Dr. Brewer later supervised
a demonstration toxemia prevention project in the prenatal clinics of Contra Costa County, California. The project started
in 1963 and continued for 12 1/2 years. During this time, "Tom supervised the prenatal management of over seven thousand
mothers from the lowest income group in the San Francisco Bay area," and the incidence of toxemia among these mothers "was
0.5 percent, with no cases reaching the convulsive stage." During this time he also "published journal articles about the
project and began lecturing at medical meetings and hospitals around the country." It wasn't until 1977 that Dr. Brewer and
his wife Gail finally turned to writing directly to the mothers themselves, teaching them how to be advocates for themselves
in the absence of that advocacy from their doctors.

You may have heard the claim that Dr. Brewer's work is not supported by the current research.

The truth is that much of the current research is deeply colored by the biases of the researchers. Those biases include the
belief that the Brewer Diet is quackery, that his studies cannot be accurately reproduced without jeopardizing the mothers
and babies being studied, and that the only safe way to study women with pre-eclampsia is to keep them on mainstream-approved
"anti-hypertensive therapies" (which usually includes low-salt, low-calorie diets).

Another truth is that I don't know that there is no current research that supports Dr. Brewer's views. When I find current
research or peer-reviewed studies that may support Brewer's views, I will post it on this website.

Another truth is that at least some of the current research doesn't seem to entirely rule out Brewer's views, as his opponents
claim that they do. At first glance some of it appears to simply be describing various functions of the placenta and other
parts of the pregnant body that Brewer also described, albeit from an end-stage perspective rather than a beginning-stage
perspective.

"Q: Scientists recently announced that certain proteins secreted by the placenta rise significantly in mothers experiencing
eclampsia, suggesting that these proteins cause eclampsia. (80,82) Are these findings significant?

Dr. Brewer: Research that's focused on "genetics" or speculative biochemical enzymatic equations never addresses the underlying
cause of an illness or condition. I don't doubt that unusual proteins are produced by a starving fetus or a starving mother,
but those proteins don't cause eclampsia. They're just another symptom. Inadequate nutrition causes eclampsia.

In a New Zealand sheep experiment published in the journal Science, none of the ewes on a normal diet had premature births,
but half of the ewes that were put on a moderate weight-loss diet at the time of conception gave birth prematurely. (83) The
researchers decided that a mother's diet before and around the time she conceives can profoundly influence the length of pregnancy,
and they called this a stunning scientific breakthrough. This is what I mean about medical researchers knowing nothing about
nutrition. It's obvious, but they didn't have a clue.

Sheep have been studied before, and they have shown all the same symptoms and problems that humans have. In one study, pregnant
sheep were starved at the very end of their pregnancies, and most of them died. Other researchers have found that sheep giving
birth to twins, triplets, or quadruplets are more likely to have toxemia than those giving birth to single lambs.

This is true for humans, too. A woman pregnant with twins has to eat for three, for herself and each of her babies, and a
woman pregnant with triplets has to eat for four. It isn't easy to do this, but the more good nutrition a woman can provide
for her developing babies, the healthier they will be. (72)"

I have heard that some pro-Brewer prenatal class teachers and midwives have been very rude and callous with their clients
when they have developed pre-eclampsia. I have heard that some of them have told their clients that if they had eaten correctly,
they wouldn't have gotten pre-eclampsia. I have heard that some of them would not return the phone calls of these clients
once they developed pre-eclampsia.

I believe these stories. When I first heard them, I was speechless with shock. I was appalled that a care-giver could respond
to any pregnant woman in this way, let alone a pregnant woman who is courageously fighting for her own life and that of her
baby, and who is in severe emotional pain, and who needs all the support and love and practical help that she can get.

I believe that most prenatal class teachers and midwives are more sensitive and wise than to respond to their clients in such
a horrendous way. I advise all of those prenatal class teachers and midwives who may not be so wise to take great care to
not respond to their clients in this way, and to take great pains to not even say words that might mistakenly be received
in this way. I advise them to receive these clients with great tenderness and compassion and to ask them what they can do
that would feel the most helpful and supportive to these clients.

I also advise prenatal class teachers and midwives to pay close attention to any morning sickness or other digestive disorders
that their clients might experience, and to treat them aggressively with homeopathy, herbs, and nutritional adjustments.
The lack of food that the mother experiences during these times could be enough to throw her into a pre-eclampsia process.

I also advise teachers and midwives to spend more time with their mothers who have blood pressures that are creeping up.
Avoid sending them home with vague instructions to eat a little more protein. Explain the importance of expanding their blood
volumes and how the body works on that process. Encourage them to eat something with protein in it every hour that they are
awake, including a bedside snack for middle-of-the-night wakings. Take a thorough history to discern their lifestyle. Find
out whether they are on an exercise program, or have a lot of stress in their lives, or work or live in over-heated conditions,
or love to garden even when it's hot outside--conditions which could lead to their losing extra calories or salt. If they
do have these factors in their lifestyle, talk with them about ways to add extra calories and salt to their diet, and possibly
ways to modify their lifestyle so that they don't lose as many calories or as much salt. Talk with them about ways to lessen
the stress in their lives, and thus burn fewer calories. Have them monitor their blood pressures a couple of times a day,
at the same times every day, while you are discerning whether these changes are making an effective difference. Encourage
them to call you once a day with their most recent blood pressure readings, and more often if they become concerned. If necessary,
send a midwife's note to their employers, prescribing a change in work responsibilities or conditions.

I have heard some people confuse the physiology of chronic hypertension with the physiology of "pregnancy induced hypertension."
They ask how extra protein can be good for "PIH", if it's not good for non-pregnant people with chronic hypertension.

The truth is that the pregnant body works differently than the non-pregnant body does. The causes of chronic hypertension
in the non-pregnant body range from stress, arteriosclerosis and atherosclerosis to kidney diseases, adrenal tumors, and coartation
of the aorta. In those cases you might want to watch the amount of protein that the patient eats. But in pregnancy, if those
diseases have been ruled out with a proper differential diagnosis, proteins are necessary for maintaining the healthy nourishment
of the kidneys and liver so that they can meet the extra stresses of pregnancy, for the formation of serum albumin, for the
maintenance of the clotting mechanisms, and for the maintenance of a healthy blood volume. This is a mechanism that occurs
only in pregnancy.

Another truth is that often those who object in this vein may not understand that the protein needed in pregnancy can come
from a variety of places--beans, nuts, dairy products, fish, and chicken. The protein needed in pregnancy does not need to
come from sources which may also come with a high-cholesterol component.

I've heard from some people who are apparently confusing the physiology of pregnancy with the physiology of congestive heart
failure, or kidney failure, or circulatory problems that come with old age. They question how adding extra salt to a diet
for pregnancy can be good for the edema of pregnancy, when extra salt is not good for people with edema caused by congestive
heart failure, kidney failure, or the poor circulation of old age.

The truth is that in congestive heart failure, kidney failure and the circulatory problems of old age, the patient's body
is dealing with a blood volume which is abnormally expanded, and one of the symptoms of this condition can be edema. This
is a disease process that must be dealt with.

The pregnant body has a different agenda than that of the non-pregnant body dealing with congestive heart failure and other
diseases. One of the most important tasks of the pregnant body is to continually work on increasing the blood volume,
which it needs to do in order to maintain the placenta in a healthy way. When this process is hindered by the lack of salt
or albumin, there may not be adequate osmotic pressure to hold fluids within the circulation, and fluids will move out from
the capillaries to the tissues (ankles, fingers, face), and you will see edema. In this situation, the edema can be a sign
of a falling blood volume, rather than an abnormally expanded blood volume, and the mother's blood volume can drop to dangerously
low levels--life-threatening levels. One of the ways to pull those fluids out of the tissues and back into the circulation
is to increase the osmotic pressure in the bloodstream, by adding salt and protein to the diet.

I've heard objections from some people who are apparently confusing the Brewer Diet with the high-protein, low-carbohydrate
Atkins Diet.

The truth is that the Brewer Diet is not a high-protein, low-carbohydrate diet. The level of protein that it recommends is
higher than that which is recommended by the ACOG diet, but the level of protein in the Brewer Diet is only 80-120 grams of
protein (except in special circumstances, such as multiple births and pre-eclampsia). But it is most emphatically true that
the Brewer Diet is NOT a low-carbohydrate diet. The Brewer Diet calls for a minimum of 2600 calories a day, and if someone
tries to eat the proteins of the Brewer Diet without the calories of the Brewer Diet, they most likely will not be able to
sustain their blood volume at the level that their pregnant body needs, and they are at risk of developing pre-eclampsia and/or
other related complications.

Some women who've had pre-eclampsia believe that if they'd not had anti-hypertensive drugs, they would have developed strokes,
and seizures, and worse.

The truth is that Dr. Brewer was able to successfully treat women with pre-eclampsia without the use of anti-hypertensive
drugs. This was his intervention program:

1) The mothers with pre-eclampsia "were placed on a high-protein (120 grams per day) diet."

2) "The mothers were placed on regular, rather than salt-restricted diets. A salt shaker appeared on the tray at each meal
and the mother was instructed to salt her food to taste."

3) "The women were encouraged to stay out of bed as much as possible, even to do the chores on the ward if they were willing,
rather than being ordered to the customary bedrest."

4) "Diuretics and drugs to lower blood pressures were not used."

5) "Following the work of Poth, on the most effective way to suppress bacterial flora in the bowel, patients received oral
antibiotics to reduce the detoxication load on their damaged livers."

6) "Tom personally discussed the program with each mother to obtain her permission and cooperation, then made a conscientious
effort to see that each followed her diet well."

Any research study which claims to try to duplicate Tom's results and does not follow the above steps is flawed and unreliable.

It is also true that while he was the chief OB/GYN resident at Jackson Memorial Hospital Dr. Brewer was successful in treating
13 out of 14 mothers "acutely ill with MTLP" (pre-eclampsia) with serum albumin, although they had initially been treated
with diuretics. The 14th mother "had a normal serum albumin concentration and minimal edema" and "she delivered soon after
admission...In none of these patients was the infusion of albumin associated with a significant rise in blood pressure, increase
in pulse rate, nor with any increase in the severity of symptoms of the disease."

Later research conducted by Dr. Stella Cloeren and Dr. Peggy Howard, done independently of each other, confirmed Dr. Brewer's
findings. In Dr. Howard's "Albumin concentrate can be used for pre-eclampsia," of OB/GYN News, Oct. 1, 1974, "All of the toxemic
women given 50 grams of serum albumin daily gave birth to babies in good health. Infusions of serum albumin improved renal
function, increased estriol excretion, prevented eclamptic convulsions, and resulted in a reduction in perinatal mortality
to one-fourth the rate of the 'controls' and eradication of abruptio placentae."

In fact, in a 2004 interview for Townsend Letter, Dr. Brewer described the further damage that can be caused
by anti-hypertensive drugs, to mothers' livers and kidneys already ravaged by the pre-eclampsia process...

Brewer: "Low blood volume, which is the inevitable result of dehydration and the use of diuretics, contributes directly to
eclampsia, premature birth, and low birth weight. (23,35,36,38) And now there's a whole group of hypertension drugs that have
come out in the last 10 to 15 years. These drugs just ravage women. They cause direct damage to all of the cells in the mother's
body, particularly to the liver, a little to the kidneys, and then to the placenta and fetus."

Anne Frye recommends having the mother eat a high protein item every waking hour. She also suggests, "Initially recommend
an increase to 150 to 200 grams of protein daily (250 to 350 grams or more with multiple gestations), with 3,000 to 4,000
calories and 500 mg of choline daily...If the woman has a history of liver disorders, recommend less protein (120-150 grams
for a single fetus); her liver may be overwhelmed otherwise, and monitor her lab work closely for changes...Once liver enzymes
and blood proteins have normalized, the hemoglobin has dropped appropriately, the fetus is an appropriate size for dates and
secondary symptoms have subsided, the woman can cut back to 100 grams of protein daily (150 grams with multiples)."

There are some who say that they were on the Brewer Diet and were well-nourished and it didn't work for them, so therefore
it must be a fallacy.

There are some who say that they have seen women who were well-nourished and who still got pre-eclampsia, so therefore it
must be a fallacy.

At least part of the truth is that there are other diseases that look like pre-eclampsia but aren't pre-eclampsia. The doctors
need to do a thorough differential diagnosis on all their patients, and not jump to snap judgments when they see symptoms
that look like pre-eclampsia.

Some of the diseases which can look like pre-eclampsia/eclampsia include urinary tract infections, kidney infections, glomerulonephritis
(Bright's disease), chronic pyelonephritis, kidney cysts and tumors, chronic hypertension, pheochromocytoma, epilepsy, brain
tumor, coarctation of the aorta, hyperthyroidism, molar pregnancy, and heart failure. One of the dangers in jumping to the
conclusion that the mother's symptoms indicate that she is developing pre-eclampsia is that if she is not developing pre-eclampsia
her true illness will not get treated. Another danger is that in the process of treating her for pre-eclampsia with mainstream
"standards of care" and "anti-hypertensive therapies", which often include low-salt, low-calorie diets, she might well develop
the pre-eclampsia that initially she did not have.

Doctors should also be more diligent about taking a history that includes an accounting of what supplements and herbal teas
the mother is using. Any supplements or herbal teas or juices which contain nettle, dandelion, celery, bilberry, or alfalfa
could be contributing to the "toxemia syndrome" which they are seeing, since all of these herbs have diuretic properties.

You may have heard that the cause of clots forming behind the placenta is usually a clotting disorder, and that the preferred
treatment is the use of anticoagulants. You may have also heard that the mother's nutrition has no effect on whether her
body will form clots behind her baby's placenta or not.

The truth is that the formation of clots behind the placenta is usually caused by an inadequately expanded blood volume, which
results in a reduction in velocity of blood flowing through the intervillous space behind the placenta, an increased viscosity
of maternal blood associated with hemoconcentration and hypoalbuminemia and hypovolemia, and an increased fibrinogen concentration
of maternal blood associated with hemoconcentration and probably hepatic injury from the Pre-eclampsia process (which is also
caused by a low blood volume).

When the placenta first implants on the inner uterine wall, it secretes enzymes which dissolve the ends of the capillaries
which come to the inner surface of the uterus. As a result, the open ends of the arterial capillaries spout little fountains
of blood behind the placenta, and the open ends of the venous capillaries return the blood to the mother's heart, like little
bathtub drains. This is called an arterial-venous shunt. A lake of blood forms behind the placenta, and the baby's capillaries
in the placenta, which remain intact (like little loops), are continually bathed in this lake of the mother's blood. Through
this process, oxygen and nutrients pass from the mother's lake of blood, through the baby's capillary walls, and into the
baby's blood stream, and waste products pass from the baby's capillaries to the mother's blood.

As the placenta grows, the lake of blood behind the placenta needs to grow, and the mother needs to grow more blood in order
to keep this lake of blood well-supplied. By the end of the pregnancy, she needs to grow her blood volume by 60% for a singleton
pregnancy (about 2 quarts/liters of blood) and 100% for a twin pregnancy (about 3.5 quarts/liters of blood). In order to
help her body to increase her blood volume in this way, the mother needs to eat a daily minimum of 2600 calories, salt to
taste, and 80-100 grams of protein for a singleton pregnancy, and more than that for a multiple pregnancy.

When the mother's blood volume fails to keep up with the growth of the placenta, through inadequate food intake, loss of salt
and fluids (from over-heated conditions or herbal diuretics), or through lifestyle conditions which use up extra calories,
the flow of blood through the a-v shunt behind the placenta slows down. The blood that is supposed to be spurting out of
the open arterial capillaries behind the placenta like little fountains, slows to a trickle, and the blood flowing through
the lake of blood behind the placenta to the open venous capillaries slows down to such a very slow rate that it begins to
clot, as blood always does when it is not flowing at a good rate.

The best way to prevent this clotting behind the placenta is for the mother to eat according to the recommendations of the
Brewer Pregnancy Diet, plus making daily adaptations, increasing the minimum levels of the Basic Plan to accommodate her personally
unique lifestyle and needs. By doing this, she will enable her body to continually expand her blood volume to normal levels,
and maintain it at a well-expanded level for the rest of the pregnancy--keeping the little capillary fountains spurting at
a good pressure, and the little capillary drains draining at a good rate, and the lake of blood behind the placenta flowing
at a good pace so that it doesn't begin to clot.

The following is reprinted from Metabolic Toxemia of Late Pregnancy, by Thomas H. Brewer, M.D., 1966 & 1982.

"Toxic Abruptio Placentae"--(p. 61)

"Elisabeth Ramsey and her co-workers have given us a clear, scientific picture of how the placental circulation works. Maternal
blood enters the intervillous space by small uterine veins on the floor of the intervillous space. Thus, the placenta has
been shown anatomically to be an arteriovenous shunt, a condition for which have had good evidence from clinical pysiological
observations. Any conditions which will lead to clot formation in the intervillous space may be regarded as playing some role
in the pathogenesis of abruption.

The following factors occur in severe MTLP [Metabolic Toxemia of Late Pregnancy/Pre-Eclampsia] and can play a role in promoting
the formation of a clot behind the placenta:

1. The human placenta creates an ARTERIO-VENOUS SHUNT (A/V) in the maternal circulation. During the last trimester of normal
pregnancy, 50 to 60 jets of arterial maternal blood spurt up against the fetal cotyledons with each maternal cardiac systole.
This blood swirls about in the intervillous space and passes via "tub drains" back into the uterine venous system.

2. The A/V shunt requires for optimal fetal growth and development an INCREASING MATERNAL BLOOD VOLUME throughout the second
trimester to a plateau which must be maintained throughout the entire third trimester.

Failure to recognize these two well-established facts has created havoc in human maternal-fetal health throughout the whole
western world, especially in the USA, Canada, and the United Kingdom. The observed reduction in utero-placental blood flow
associated with common human reproductive pathology has not been correctly interpreted as the result of hypovolemia, failure
to maintain a physiological expansion of maternal blood volume.

Physicians commonly carry out dietary restrictions of calories and sodium and give drugs, diuretics, sodium substitutes, anorexiants,
vasodilators etc. which actually cause and/or enhance maternal hypovolemia. Intrauterine fetal growth retardation (IUGR)
and small for gestational age (SGA) babies have increased dramatically since the 1950s, especially in these three nations,
where the role of prenatal malnutrition in causing human reproductive casualty is still universally denied by medical authorities.
Applied physiology and basic nutrition science in human prenatal care as a routine for all women all through gestation must
form the basis of true, primary prevention in this field.

You may have heard the emphatic assertion by some people that there is no connection between maternal nutrition and the development
of pre-eclampsia.

The truth is that a recent study from Denmark (Sept. 2008) seems to support the Brewer principle that there indeed is a connection
between nutrition and the development of pre-eclampsia. This study has found that there is a correlation between certain
amounts of recreational exercise in pregnancy and the development of pre-eclampsia. For over 30 years, those who support
the Brewer principles have been saying that when pregnant women have extra recreational exercise or other physical exertion
in their lives, they need to compensate for the extra losses of salt, fluids, and calories that result from that extra exercise
and physical activity. When they do not increase the levels of salt, calories, fluids, and protein in their diets to compensate
for their personally unique lifestyle, they will probably experience a falling blood volume. A blood volume that is too low
for the stage of pregnancy that the mother is in will result in the development of a rising BP, pathological edema, pre-eclampsia,
and HELLP, as well as other complications associated with low blood volume, such as IUGR, premature labor, placental abruption,
and low birth weight.

This particular study was looking at only pre-eclampsia, and only at recreational exercise, but those of us who understand
the Brewer principles understand that the same principles do apply to all of the other complications associated with low blood
volume as well, and to any source of salt/fluid/calorie/protein loss.

You may have heard some mothers tell of how they were on a healthy enough diet during pregnancy, even though it was not a
Brewer-style diet, and still got a high blood pressure, or pre-eclampsia, or HELLP, or IUGR, or premature labor, or some other
complication associated with low blood volume.

You may have heard other mothers tell of how they were on the Brewer Diet and still got a high blood pressure, or one of the
other complications listed above.

You may even have heard of one mother who tells of how she was eating some protein every hour to try to alleviate her pre-eclampsia
symptoms, and that in spite of all of her valiant efforts, she still developed pre-eclampsia.

The truth is that the standard of what is included in the definition of a "healthy" diet is so variable from person
to person that there is no way to know whether each mother who says that she was on a healthy enough diet was on a diet that
was adequate for her stage of pregnancy and her lifestyle. So there is no way to know whether those mothers were actually
eating enough of the foods needed for keeping their blood volumes well expanded.

The truth is that even when a mother believes herself to be on the Brewer Diet, there are so many different definitions out
there of "Brewer Diet" that there is no way to know whether these mothers were actually on the version of the Brewer
Diet that is the most helpful and effective for keeping the blood volume well expanded.

The truth is that even when a mother tells of how she was working so hard to eat some kind of protein every hour, there is
no way to know whether she was also eating enough salt and calories every hour as well. Without enough salt and calories
in the diet, as well as enough protein, the Brewer Diet is not likely to work as well as it could for expanding the mother's
blood volume to where it needs to be.

The truth is that we usually don't hear any of these mothers tell us whether they were also on low-salt diets or low-calorie
diets during the time that they were trying to fight pre-eclampsia (or some other complication) with a high-protein diet,
or some other diet they believe was healthy enough.

The truth is that we usually don't hear from any of these mothers about what kind of lifestyle they were experiencing at the
time that they were developing pre-eclampsia, or HELLP, or IUGR, or some other complication associated with blood volume issues.
We don't hear how much exercise they were doing every day, or what kinds of physical exertions they were having to perform
every day, or whether they were living or working in over-heated environments, or whether they were outside on hot days (gardening
or on vacation or at theme parks), or whether their jobs were physically demanding (like dancing, or teaching, or nursing,
or teaching exercise classes, or waitressing, or working in a factory), or whether they were having to go through a move during
the pregnancy, or how many other children or parents they were caring for at home. If the mother is not taught how to compensate
for these kinds of stressors and salt-fluid-calorie losses, all of these factors can contribute to a falling blood volume
and resulting complications, such as a rising BP, PE, HELLP, IUGR, premature labor, and other complications associated with
a low blood volume.

The truth is that even if a mother was using an excellent version of the Brewer Diet, and had adapted it to fit her unique
needs, and had adjusted her lifestyle in a way that should assist her body in its blood-volume-expansion task, we have no
way of knowing whether she was also taking some herbal tea or herbal supplement which has diuretic properties and was counteracting
all of her great efforts to expand her blood volume through nutrition.

The truth is that even anti-hypertensive drugs can contribute to liver damage, which can add to the low-blood-volume issue,
adding to the development of BP issues, PE, HELLP, or other complications. When the liver is compromised, it cannot produce
the amount of albumin that is necessary to help expand the blood volume during pregnancy, and it cannot produce the clotting
factors that are necessary for keeping the clotting mechanisms of the body at a normal capacity.

Brewer: "Low blood volume, which is the inevitable result of dehydration and the use of diuretics, contributes directly to
eclampsia, premature birth, and low birth weight. (23,35,36,38) And now there's a whole group of hypertension drugs that have
come out in the last 10 to 15 years. These drugs just ravage women. They cause direct damage to all of the cells in the mother's
body, particularly to the liver, a little to the kidneys, and then to the placenta and fetus."

The truth is that many of the "anti-hypertensive treatments" and "standards of care" of mainstream obstetrics
and perinatology can counteract the efforts of the mother to eat the amount and type of food that she needs to maintain her
blood volume at the well-expanded level needed for whatever stage of her pregnancy she has come to.

The truth is that at the first sign of a rising hemoglobin/hematocrit, or of a rising BP, or of any other symptom of PE, or
IUGR, or premature labor, some kind of experienced Brewer Diet counselor should sit down with the mother and examine with
her all of the components of her diet and of her lifestyle.In this way, together they can develop a plan for a good fit
between the needs of her pregnancy, the needs of her lifestyle, and the needs of her diet.

You may have read on an anti-Brewer forum a post which implies that only DEMs (direct entry midwives) are in support of the
Brewer Diet,
and that they do so only because they don't know any better.

You may have also read in that post the opinion that DEMs "have very little scientific or medical training", and that they
are "not very grounded in sound risk management techniques".

You may have also read in that post the implication that the reason that DEMs have chosen to not become CNMs, or DOs, or MDs
is that they don't want to take the time to do that.

The truth is that many childbirth professionals other than DEMs use and support the use of the Brewer Diet in pregnancy.
In the fall of 2008 I started a registry of Brewer Diet supporters. By the end of 2008, hundreds of people had asked to join
that registry--professionals from 13 countries and 49 US states. They include NDs (naturopathic doctors), DOs (doctors of
osteopathy), including one who is a FACOOG (the DO version of an obstetrician/gynecologist), PhDs (including a nutritionist),
an MPH (Masters in Public Health), MSWs, CNMs, MSNs (Masters of Science in Nursing), RNs, LPNs, DEMs, CPMs, LMs, doulas, and
childbirth educators.

I am especially encouraged by those who sent me notes along with their requests for being listed on the registry. Many of
these notes told of their successful use of the Brewer Diet in their practices, and some of them had been seeing this success
for 30 years! It is so encouraging to know that thousands of women and their babies have been helped and protected for so
many years, through the teaching and guidance of so many highly educated birth professionals.

The truth is that there is more than one kind of DEM. There are DEMs who may choose to not be licensed anywhere, for any
number of valid reasons, but some of these may also be RNs, or CNMs from other countries, or even MDs from other countries,
or even professionals who are well-educated by other means. There are also DEMs who are CPMs (certified professional midwives)
or LMs (licensed midwives). These latter two categories are midwives who have undergone a rigorous education and certification
and licensing process. According to the North American Registry of Midwives (NARM), "The Certified Professional Midwives'
credentialing process was evaluated by independent researchers at Ohio State University as a credential that exemplified the
established standards for educational and psychological testing, as determined by the American Educational Research Association,
American Psychological Association, and the National Council of Measurement in Education". The CPMs hold valid, state-recognized
licenses in the states where they are licensed. There are at least 23 US states which license direct-entry midwives who are
certified through these direct-entry midwifery programs.

The truth is that medical training is only for medical doctors. Direct-entry midwives prefer to be educated in programs which
will prepare them in caring for women planning to have natural childbirth, an area of the childbearing field that medical
schools in the United States teach nothing about, and an area about which most US medical doctors know very little, if anything.
Those US medical doctors who do understand and support natural childbirth are few and far between. They are the heroes of
our time, the hidden treasures in our communities. If any of you come across one of them, please let them know that I would
gladly welcome any of them to the Brewer Diet Registry, a registry of childbirth professionals who use and support the use
of the Brewer Diet and Brewer principles.

According to NARM, CPMs are educated in giving the following kind of care:

monitoring the physical, psychological, and social well-being of the mother throughout the childbearing
cycle;

The truth is that DEMs do not choose against becoming CNMs, or DOs, or MDs to avoid taking the time to do the
work of that option. The truth is that DEMs probably choose to become DEMs because they prefer to perform in the style and
scope of care that DEMs provide, rather than in the styles and scopes of care that CNMs or DOs or MDs provide.

As a matter of fact, one of the CPMs on our registry of Brewer Diet supporters is a woman who is a former CNM (certified nurse
midwife) who also went on to get her MSN-NM (Masters of Science in Nursing-Nurse Midwifery). She "began a hospital based
practice", and "over a 3 year period [she] introduced water birth and many other natural child birth friendly options
for mothers" there. But at the end of that time, she "fulfilled a long time dream and opened a home birth practice.
She dropped her certification as a nurse-midwife and took yet another national board exam and became a certified professional
midwife through the North American Registry of Midwives." So as you can see through this midwife's choices, there is
a lot more substance to a woman's choice to become a CPM rather than a CNM than might immediately seem apparent to those with
a mainstream medical perspective.

You may have heard that eating extra protein in pregnancy can cause kidney damage.

You may have heard that eating extra protein in pregnancy can cause protein to appear in the urine.

The truth is that during pregnancy the kidneys are stressed by the pregnancy itself,
and that eating extra protein during pregnancy actually protects healthy kidneysfrom being damaged by those extra stresses.

The truth is that the appearance of protein in the urine can suggest either kidney damage (from pre-eclampsia or from
other causes), or a kidney or bladder infection, or some other kidney disease, such as glomerulonephritis (Bright's
disease), chronic pyelonephritis, kidney cysts, or tumors.

The truth is that protein in the urine does not occur as a result of whatever amount of protein is in the mother's diet.
Under normal circumstances (pregnancy being one of the normal states of the female body), the protein molecule is too large
to pass through the filtration system of the kidney,
no matter how much protein the mother eats.
That is why protein in the urine can suggest that there is possibly some kind of damage somewhere in the kidney's filtration
system,damage which is allowing the large protein molecule to slip through where ordinarily it would not be allowed to
slip through.

Sometimes protein can get added to the urine after it leaves the kidneys, and thus it would not be connected to any kind
of kidney damage. Sometimes this can happen when there is a bladder infection. Sometimes it can happen when there
is a yeast infection in the vagina and some protein from that infection can accidently get into the urine when the specimen
is being collected. Sometimes protein can get into the urine specimen when normal discharge from the vagina gets
mixed with the urine specimen as it's being collected.

So if protein shows up in your urine specimen, the first idea you can try is to ask your midwife or the nurse in your doctor's
office to teach you how to do a "clean catch" for your urine specimen, to eliminate any source of any kind of discharge that
may have accidently been added to the specimen as you were urinating into the cup the previous time. The second idea you
can try is to ask your midwife or doctor to send your urine specimen to a lab to see if you might have a kidney or bladder
infection. The third idea you can try is to ask your midwife or doctor to do a differential diagnosis for the other illnesses
which could cause protein to appear in the urine.

The following is copied from the FAQ page of this website.

Q: Doesn't eating this much protein place stress on the pregnant body? Couldn't eating this much protein cause kidney
problems?

A: "The stress in pregnancy comes from the continuous demands of the growing baby, the growing placenta, and the expansion
of your blood supply to keep the placenta in good working order. All these considerations require protein above and beyond
what would be adequate for a nonpregnant woman. So adding protein to your diet does not constitute a stress--in fact, it's
helping to counteract a stress that pregnancy itself imposes.

Additional protein could cause difficulty only if your liver were impaired and couldn't clear the body of the waste products
of protein metabolism, or if you were undergoing severe kidney failure. In each of these circumstances, eating protein in
large amounts could be toxic, but eating protein sufficient for a healthy pregnancy would not cause the problems to
arise. High blood pressure in pregnancy can be triggered by a lack of protein, not an excess."

Q: Some people say that too much protein is harmful. What is the upper limit of safety in pregnancy?

A: Nobody knows, but it certainly isn't the 45 to 60 grams a day some writers propose. In very carefully controlled research
at the University of California at Berkeley, for instance, pregnant women were fed diets that contained varying levels of
protein--up to 120 grams a day--and it was found that their bodies were still using the protein even at the highest levels
of intake.

The theory behind the thinking of those who are leery of protein is that when you eat large amounts of protein, you create
a higher level of metabolic by-products that the liver and kidneys must clear from the body. The fear is that the by-products
will overpower the body's ability to handle them. This line of reasoning misses an important point: When you have a completely
adequate diet, the liver and kidneys get their share of essential nutrients and so step up their clearance rate with no
difficulty whatever. In short, you can't overdose on the levels of protein this diet provides--and probably not at levels
significantly higher, either.

Dr. Maurice Strauss, a noted internist at Harvard in the 1930s, placed toxemic pregnant women on therapeutic diets up to 260
grams of protein a day and had consistently excellent results in turning their disease around. Of course, we're not advocating
this amount of protein for every pregnant woman every day, but it should make the point that protein per se will not poison
you or your unborn baby. The real problem, as we will see over and over as we discuss various aspects of pregnancy, is protein
deficiency, not protein excess.